Europe's plans for dealing with pandemic influenza are broadly good but gaps remain and substantial variation exists between countries, according to a study published online today (Thursday April 20, 2006) by The Lancet.

In 2005, the World Health Organization (WHO) published a checklist to help countries prepare for pandemic influenza. Most European countries have now published national preparedness plans.

Richard Coker (The London School of Hygiene and Tropical Medicine, UK) and colleagues evaluated the plans of 25 European Union countries, two acceding countries (Bulgaria and Romania) and two non-EU countries (Norway and Switzerland) against criteria taken from WHO's checklist. Of the 21 countries' plans available, they found that surveillance planning, coordination, and communication were good but maintenance of essential services, putting plans into practice, and public-health interventions were less well prepared. Seven plans did not address the need to prepare for maintenance of essential services. In terms of putting plans into action, only a small minority of countries specified clearly which institutions would operate the health care triage system. Only seven countries provided some detail of their policies on storage and distribution of antivirals. The implementation of public-health interventions was unclear in many plans, state the authors. All but two countries advised at least one measure of non-medical public health control.

Stockpile provisions for individual countries varied greatly, ranging from 2% to 53% population coverage. However, the authors note that the true situation in countries remains unclear and is constantly changing. Most countries' plans estimated death rates between 230 and 465 per 100 000. Expected hospital admission rates varied between 40 and 2707 per 100 000.

Few countries addressed the need for collaboration with adjacent countries. This omission needs to be addressed state the authors, especially to avoid patients travelling across national borders in expectation of better health care.

Dr Coker states: "Europe has the resources to prepare for pandemic influenza. Governmental commitment in most European countries is strong, preparedness levels are broadly good, surveillance and monitoring capacities allied to laboratory capacity are well developed, and the public-health infrastructure is robust. However, gaps in preparedness planning seem to remain, and variations exist between nation states. Improved cooperation between countries is needed, to share experiences and to ensure coherence of approaches."

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See also accompanying Comment.

Contact: Dr Richard Coker, Reader in Public Health, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. T): +44 (0) 2079272926 richard.coker@lshtm.ac.uk